Science, Maddá, and 'Ilm: The language divide in scientific information available to Internet users.

The Internet has potential to alleviate inequality in general and specifically with respect to science literacy. Nevertheless, digital divides persist in online access and use, as well as in subsequent social outcomes. Among these, the "language divide" partly determines how successful users are in their Internet use depending on their proficiency in languages, and especially in English. To examine whether the quality of online scientific information varies between languages when conducting searches from the same country, we compared online search results regarding scientific terms in English, Hebrew, and Arabic. Findings indicate that searches in English yielded overall higher quality results, compared with Hebrew and Arabic, but mostly in pedagogical aspects, rather than scientific ones. Clustering the results by language yielded better separation than clustering by scientific field, pointing to a "language divide" in access to online science content. We argue that scientific communities and institutions should mitigate this language divide.1.

Mathematical media literacy in the COVID-19 pandemic and its relation to school mathematics education.

In the first months of 2020, as the COVID-19 pandemic became a top concern worldwide, media coverage became full of information that demands mathematical literacy, or numeracy, to interpret. In this study, we examine the public's understanding of mathematical notions that are required for understanding the pandemic and predicting its spread. We also explore its correlations with several variables: age group and gender, educational attainment in mathematics, and mathematics identity. To do so, we conducted a cross-sectional survey focusing on mathematical knowledge relevant to the pandemic. The survey was distributed to a representative sample of the Jewish Israeli population (n = 439). Findings showed that participants' educational attainment in mathematics was positively correlated with their success in the mathematical media literacy tasks. However, even those with high attainment levels did not always perform well. Moreover, the explanatory variable with the strongest relationship to mathematical media literacy was found to be participants' mathematical identity. These results suggest that school mathematics, especially in its high levels, may prepare adults to understand critical information important for their well-being, such as at a time of global pandemic. However, they also demonstrate that a weak mathematical identity may significantly hinder adults' engagement with such information. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10649-021-10075-8.

Vaccine information seeking on social Q&A services.

Experts are concerned about the spread and recalcitrance of vaccine misinformation and its contribution to vaccine hesitancy. Despite this risk, little research attention has been paid to understanding how individuals seek vaccine information online and evaluate its trustworthiness. Here, we hypothesized that when vaccine-hesitant parents seek information about vaccines, they prefer trustworthy sources based on their competence, integrity and benevolence. We explored this issue using 4910 questions and 2583 answers retrieved from two social question-and-answer (Q&A) platforms: "Yahoo! Answers" and the Facebook group "Talking about Vaccines." We examined what kinds of questions are asked about vaccines, to what extent they are explicitly directed at health professionals or parents, and what features of the answers predict perceived answer quality, based on the theory of epistemic trust. The findings indicate that on different platforms, vaccine-related questions focus on different topics; namely, questions on one platform focused on the risks and benefits of vaccination, whereas they dealt with vaccine schedules on the other. On both platforms, most questions did not specify that an answer should be based on professional expertise or parents' experience. Both pro-vaccine and anti-vaccine answers were proportionately represented among the "best answers". However, if an answer was written by a health professional, the askers and the community on "Yahoo! Answers" were twice as likely to choose it as the "best answer" to a vaccine-related question, irrespective of whether it encouraged or discouraged vaccination. By contrast, an online experiment revealed that both the identity of the respondent and the stance towards vaccination affected the perceived trustworthiness of the answers. These findings indicate that despite the proliferation of anti-vaccine messages, epistemic trust in mainstream science and medicine is robust. User responses to expert answers suggest that expert outreach in online environments may be an effective intervention to address vaccine hesitancy.

The experts' perspective of "ask-an-expert": An interview-based study of online nutrition and vaccination outreach.

Social media allow experts to form communities and engage in direct dialogue with publics, which can promote mutual understanding between sciences and publics. However, little is known about experts' participation in online communities, or effective ways to prepare them for public engagement. Here, we explored these issues with experts who voluntarily engage with publics on social media, to understand their public engagement practices. Stimulated recall interviews were conducted with 20 experts who participate in question-and-answer Facebook groups dedicated to vaccines and nutrition. The findings suggest that experts employ diverse considerations in their outreach, partly to establish epistemic trustworthiness. These can be grouped into three goals and two constraints: countering misinformation, establishing benevolence, and establishing competence while maintaining integrity and clarity. Empathic failure and burnout both emerged as factors that impair establishing benevolence. We discuss implications for community-level science literacy and for preparing scientists for "bounded engagement with publics."

International consensus (ICON) on assessment of oropharyngeal dysphagia.

OBJECTIVE: To present international recommendations regarding the proper evaluation of oropharyngeal dysphagia (OD), both objectively and subjectively (self-evaluation). METHODS: Following a thorough review of the literature, 5 experts in the field from 4 different continents answered separately a questionnaire regarding the work-up of OD. Individual answers were presented and discussed during the world ENT conference that was held in Paris in June 2017. This article will present the recommendations issued from that meeting. RESULTS: For the initial objective assessment of OD, it is recommended to perform either a functional endoscopic evaluation of swallowing (FEES) or a videofluoroscopic swallowing study (VFSS). FEES is the more popular investigation given its increased ease of use and accessibility. When evaluating for the presence of aspiration during the objective evaluation of OD, it is recommended to perform either a FEES or a VFSS. In this case, FEES is the favored investigation given its likely increased sensitivity. In order to highlight the presence of oropharyngeal food residue following the deglutition process, it is recommended to perform either a FEES or a VFSS; FEES likely being the more sensitive investigation while VFSS allows a better quantification of the amount of pharyngeal residue. Is it also recommended to objectify the quality of the deglutition process by means of a score during the objective evaluation of OD. Finally, it is recommended to utilize a self-evaluation questionnaire during research studies exploring the deglutition process.

Temporal patterns of scientific information-seeking on Google and Wikipedia.

In response to the news coverage of scientific events and to science education, people increasingly go online to get more information. This study investigates how patterns of science and technology information-seeking on Google and Wikipedia change over time, in ways that differ between "ad hoc" terms that correspond to news coverage and "cyclic" terms that correspond to the academic period. Findings show that the science and technology activity in Google and Wikipedia was significantly associated with ad hoc and cyclic patterns. While the peak activity in Google and Wikipedia largely overlapped for ad hoc terms, it mismatched for cyclic terms. The findings indicate the importance of external cues such as news media and education, and also of the online engagement process, and particularly the crucial but different role played by Google and Wikipedia in gaining science and technology knowledge. Educators and policy makers could benefit from taking into account those different patterns.

Footprints of Fascination: Digital Traces of Public Engagement with Particle Physics on CERN's Social Media Platforms.

Although the scientific community increasingly recognizes that its communication with the public may shape civic engagement with science, few studies have characterized how this communication occurs online. Social media plays a growing role in this engagement, yet it is not known if or how different platforms support different types of engagement. This study sets out to explore how users engage with science communication items on different platforms of social media, and what are the characteristics of the items that tend to attract large numbers of user interactions. Here, user interactions with almost identical items on five of CERN's social media platforms were quantitatively compared over an eight-week period, including likes, comments, shares, click-throughs, and time spent on CERN's site. The most popular items were qualitatively analyzed for content features. Findings indicate that as audience size of a social media platform grows, the total rate of engagement with content tends to grow as well. However, per user, engagement tends to decline with audience size. Across all platforms, similar topics tend to consistently receive high engagement. In particular, awe-inspiring imagery tends to frequently attract high engagement across platforms, independent of newsworthiness. To our knowledge, this study provides the first cross-platform characterization of public engagement with science on social media. Findings, although focused on particle physics, have a multidisciplinary nature; they may serve to benchmark social media analytics for assessing science communication activities in various domains. Evidence-based suggestions for practitioners are also offered.

Measuring mumbo jumbo: A preliminary quantification of the use of jargon in science communication.

Leaders of the scientific community encourage scientists to learn effective science communication, including honing the skill to discuss science with little professional jargon. However, avoiding jargon is not trivial for scientists for several reasons, and this demands special attention in teaching and evaluation. Despite this, no standard measurement for the use of scientific jargon in speech has been developed to date. Here a standard yardstick for the use of scientific jargon in spoken texts, using a computational linguistics approach, is proposed. Analyzed transcripts included academic speech, scientific TEDTalks, and communication about the discovery of a Higgs-like boson at CERN. Findings suggest that scientists use less jargon in communication with a general audience than in communication with peers, but not always less obscure jargon. These findings may lay the groundwork for evaluating the use of jargon.

Office-based esophagoscopy: a preliminary report.

OBJECTIVE: Preliminary study that describes unsedated, transnasal esophagoscopy (TNE) in an office setting. STUDY DESIGN AND SETTING: TNE was prospectively performed on 14 consecutive out-patients with dysphagia whose initial oropharyngeal dysphagia evaluation was insufficient to reveal the cause of their swallowing problem. TNE was carried out without conscious sedation while the patients were sitting in an examining chair. Ease of endoscope insertion, optical quality of images, and examination findings were assessed. Heart rate before and after the procedure and incidence of epistaxis and airway compromise was also determined. Patients were asked to rate the level of discomfort of TNE on a validated 10-point scale (1 representing none/well tolerated and 10 severe/poorly tolerated). RESULTS: All patients completed TNE with the esophagus readily intubated and esophageal mucosa clearly visualized. Findings included esophageal stricture, patulous upper esophageal sphincter, and Zenker's diverticulum. There were no incidences of epistaxis or airway compromise and no significant changes in heart rate. Overall tolerance of TNE was rated by the patients as 2.0 (SD, 1.2). CONCLUSIONS: TNE is well tolerated and can be safely performed in patients with dysphagia in an office setting. TNE may have a role in the comprehensive evaluation of the dysphagic patient in the office.

Cost-effectiveness of two types of dysphagia care in head and neck cancer: a preliminary report.

We conducted a prospective, preliminary study to compare the cost-effectiveness of two different instrument-based techniques for diagnosing and managing dysphagia in 30 consecutive hospitalized patients with head and neck cancer. The two techniques are videofluoroscopy via modified barium swallow (MBS) and videoendoscopy via flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Medicare was the primary insurer of all patients. Fifteen of these patients had their dysphagia diagnosed and managed by MBS and the other 15 by FEESST. Cost-effectiveness was assessed by determining the average Medicare reimbursement for each procedure. We found that the mean reimbursements were $451.01 (+/- $50.55) for MBS and $321.23 (+/- $3.01) for FEESST. The mean reimbursement for FEESST was significantly lower than that for MBS (p < 0.0001; Mann-Whitney U test). We conclude that FEESST appears to be more cost-effective than MBS for the inpatient management of dysphagia in patients with head and neck cancer.

Laryngopharyngeal sensory deficits in patients with laryngopharyngeal reflux and dysphagia.

There are no reliable means of quantifying the edema that results from acid exposure to the posterior larynx in patients with laryngopharyngeal reflux (LPR). However, it is possible to quantify laryngopharyngeal sensitivity in these patients by endoscopic administration of air pulses to the laryngeal mucosa in order to elicit the laryngeal adductor reflex. The purpose of this study was to determine whether patients with LPR have sensory deficits in the laryngopharynx, and whether treatment of these patients with a proton pump inhibitor (PPI) results in resolution of sensory deficits. Flexible endoscopic evaluation of swallowing with sensory testing was prospectively performed in 54 patients with dysphagia without neurologic disease and in 25 healthy controls. The laryngopharyngeal sensory level, posterior laryngeal edema, and LPR were assessed. We defined LPR as passage of food material from the esophageal inlet retrograde into the hypopharynx. Patients with LPR were placed on 3 months of omeprazole or lansoprazole and then retested. Patients without LPR were placed on H2 blockers for 3 months and then retested. In the dysphagia group, 48 of 54 patients (89%) had edema of the posterior larynx, and 42 of 54 (78%) had laryngopharyngeal sensory deficits. We noted LPR in 38 of 54 (70%). In the control group, 1 of 25 subjects (4%) had edema, sensory deficits, and LPR. The differences in incidence of edema, sensory deficits, and LPR between the dysphagia group and the control group were significant (p < .001, chi2 test). Twenty-three patients with LPR placed on a PPI returned for follow-up, with improvement in laryngeal edema in 14 of the 21 (67%) who had pretreatment edema and resolution of sensory deficits in 15 of the 19 (79%) who had pretreatment deficits. In the non-LPR, non-PPI group, 11 of 16 patients returned for follow-up, with improvement in laryngeal edema in none of the 11 and improvement in sensory deficits in 1 of the 11 (9.1%). The differences in improvement in laryngeal edema and sensory deficits between the LPR, PPI group, and the non-LPR, non-PPI group were significant (p < .01, Fisher's exact test). We conclude that patients with dysphagia and edema of the posterior larynx as a result of LPR have sensory deficits in the laryngopharynx. Treatment of these patients with a PPI appears to result in resolution of laryngopharyngeal edema and improvement of sensory deficits, both subjectively and objectively.

Endoscopic evaluation of swallowing as an alternative to 24-hour pH monitoring for diagnosis of extraesophageal reflux.

Patients with symptoms of extraesophageal reflux may not be eager to undergo 24-hour pH probe monitoring for the sake of a definitive diagnosis. It has been anecdotally noted that extraesophageal reflux can be detected during an endoscopic swallowing evaluation. The purpose of this pilot study was to demonstrate that flexible endoscopic evaluation of swallowing with sensory testing (FEESST) can be implemented to identify and subsequently treat patients with extraesophageal reflux. Over a 6-month period, FEESST was prospectively performed in 20 healthy control subjects and in 20 patients with dysphagia. The dysphagic patients did not have a history of stroke or chronic neurologic disease. Attention was specifically directed toward noting the presence or absence of reflux into the laryngopharynx during the endoscopic swallowing evaluation. None of the control subjects were noted to have reflux during FEESST, but 18 of the 20 patients with dysphagia were found to have reflux during the evaluation; this difference was statistically significant (p < .001, Fisher's exact test). We conclude that FEESST is useful as a means of diagnosing extraesophageal reflux in patients with dysphagia.

Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia.

OBJECTIVE: Aspiration pneumonia is a significant cause of morbidity and mortality in both acute and long-term care settings While there are many reasons for patients to develop aspiration pneumonia, there exists a strong association between difficulty swallowing, or dysphagia, and the development of aspiration pneumonia The modified barium swallow test (MBS) and endoscopic evaluations of swallowing are considered to be the most comprehensive tests used to evaluate and manage patients with dysphagia in an effort to reduce the incidence of pneumonia. The purpose of this study was to provide an initial investigation of whether flexible endoscopic evaluation of swallowing with sensory testing (FEESST) or MBS is superior as the diagnostic test for evaluating and guiding the behavioral and dietary management of outpatients with dysphagia. FEESST combines the standard endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. STUDY DESIGN: Randomized, prospective cohort outcome study in a hospital-based outpatient setting. METHODS: One hundred twenty-six outpatients with dysphagia were randomly assigned to either FEESST or MBS as the diagnostic test used to guide dietary and behavioral management (postural changes, small bites and sips, throat clearing). The outcome variables were pneumonia incidence and pneumonia-free interval. The patients were enrolled for 1 year and followed for 1 year. RESULTS: Seventy-eight MBS examinations were performed in 76 patients with 14 patients (18.41%) developing pneumonia; 61 FEESST examinations were performed in 50 patients with 6 patients (12.0%) developing pneumonia These differences were not statistically significant (chi2 = 0.93, P = .33). In the MBS group the median pneumonia-free interval was 47 days; in the FEESST group the median pneumonia-free interval was 39 days Based on Wilcoxon's signed-rank test, this difference was not statistically significant (z = 0.04, P = .96). CONCLUSION: Whether dysphagic outpatients have their dietary and behavioral management guided by the results of MBS or of FEESST, their outcomes with respect to pneumonia incidence and pneumonia-free interval are essentially the same.

Clinical assessment of pharyngolaryngeal sensitivity.

The purpose of this article is to review the ongoing clinical research on assessment of laryngeal and pharyngeal sensitivity with particular emphasis on the technique of endoscopic air pulse stimulation of the laryngopharyngeal mucosa. Studies of laryngopharyngeal sensation in healthy controls and in stroke patients with dysphagia are presented initially. What then follows is a detailed description of a study comparing modified barium swallow and pharyngolaryngeal sensory testing as predictors of aspiration pneumonia after stroke. Finally, the combination of laryngopharyngeal sensory testing with endoscopic swallowing evaluations, termed flexible endoscopic evaluation of swallowing with sensory testing, and its implications in the office or bedside evaluation of the patient with dysphagia are discussed.

The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations.

We assessed the safety of a new office or bedside method of evaluating both the motor and sensory components of swallowing called flexible endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air-pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Endoscopic assessment of laryngopharyngeal sensory capacity followed by endoscopic visualization of deglutition was prospectively performed 500 times in 253 patients with dysphagia over a 2.5-year period in a tertiary care center. The patients had a variety of underlying diagnoses, with stroke and chronic neurological disease predominating (n = 155). To determine the safety of FEESST, the presence of epistaxis, airway compromise, and significant changes in heart rate before and after the evaluation were assessed. Patients were also asked to rate the level of discomfort of the examination; 498 evaluations were completed. There were three instances of epistaxis that were self-limited. There were no cases of airway compromise. There were no significant differences in heart rate between pre- and posttest measurements (p > 0.05). Eighty-one percent of patients noted either no discomfort or mild discomfort as a result of the examination. In conclusion, FEESST is a safe method of evaluating dysphagia in the tertiary care setting and may also have application for the chronic care setting.

Laryngopharyngeal sensory discrimination testing and the laryngeal adductor reflex.

Laryngopharyngeal sensory capacity has been determined by endoscopically administering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve and asking the patient if he or she feels the stimulus. A potential shortcoming of this psychophysical testing (PT) procedure is that it is a subjective test, and patients with impaired cognition may not be able to perform the required task. In the search for an objective measure of laryngeal sensory function, we have observed that the laryngeal adductor reflex (LAR) is evoked at stimulus intensities similar to those capable of eliciting the psychophysical, or perceptual, response. The purpose of this study is to determine if the threshold for eliciting the LAR is the same as that of the sensory threshold. A specially designed endoscope was used to present air pulse stimuli (range 0.0 to 10 mm Hg) to the laryngopharynx in 20 healthy subjects and in 80 patients with dysphagia, using both PT and the LAR. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 65). In the control group and in the group of patients with dysphagia, there was no statistically significant difference between the median laryngopharyngeal sensory thresholds whether we used PT or the LAR (p>.05, Wilcoxon signed-rank test). The intraclass correlation for the total sample was .999 (U = .999, L = .998). Since psychophysical and sensorimotor reflex thresholds were not statistically significantly different and the intraclass correlation was close to a perfect correlation, we conclude that the LAR can be used as an objective and accurate clinical method of endoscopically assessing laryngopharyngeal sensory capacity.

Giant cell tumors of the jugular foramen.

PURPOSE: To review the diagnosis and treatment of giant cell tumors of the jugular foramen. MATERIALS AND METHODS: A typical case is reported. Symptoms, signs, and diagnostic studies are reviewed. Photomicrographs and angiographic studies showing the differences between these and glomus jugulare tumors are provided. A coherent approach to their management is presented. RESULTS: These hypervascular, traditionally radioresistant tumors may cause pulsatile tinnitus, conductive hearing loss, and lower cranial nerve paresis. Angiographic studies showed a hypervascular lesion supplied by numerous small branches of the external carotid artery, making embolization difficult. Complete resection was achieved by an infratemporal fossa approach with preoperative embolization. CONCLUSION: Giant cell tumors of the temporal bone may mimic glomus jugulare tumors with respect to anatomic location, cranial nerve deficits, and vascularity.

FEESST: a new bedside endoscopic test of the motor and sensory components of swallowing.

We here introduce an office or bedside method of evaluating both the motor and sensory components of swallowing, called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal (LP) sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Endoscopic assessment of LP sensory capacity followed by endoscopic visualization of deglutition was prospectively performed 148 times on 133 patients with dysphagia over an 8-month period. The patients had a variety of underlying diagnoses, with stroke and chronic neurologic disease predominating (n = 94). Subsequent to LP sensory testing, a complete dysphagia evaluation was conducted. Various food and liquid consistencies were dyed green, and attention was paid to their management throughout the pharyngeal stage of swallowing. Evidence of latent swallow initiation, pharyngeal pooling and/or residue, laryngeal penetration, laryngeal aspiration, and/or reflux was noted. Recommendations for therapeutic intervention were based on information obtained during the FEESST and often involved the employment of compensatory swallowing strategies, modification of the diet or its presentation, placement on non-oral feeding status, and/or referral to other related specialists. All patients successfully completed the examination. In 111 of the evaluations (75%), severe (>6.0 mm Hg air pulse pressure [APP]) unilateral or bilateral LP sensory deficits were found. With puree consistencies, 31% of evaluations with severe deficits, compared to 5% of evaluations with either normal sensitivity or moderate (4.0 to 6.0 mm Hg APP) LP sensory deficits, displayed aspiration (p < .001, chi2 test). With puree consistencies, 69% of evaluations with severe deficits, compared to 24% with normal or moderate deficits, displayed laryngeal penetration (p < .001, chi2 test). FEESST allows the clinician to obtain a comprehensive bedside assessment of swallowing that is performed as the initial swallowing evaluation for the patient with dysphagia.

Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) in healthy controls.

The purpose of this study was to introduce a new method of bedside assessment of both the motor and sensory components of swallowing called fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST). This approach combines the established bedside endoscopic swallowing evaluation with a more recently described technique that allows objective determination of laryngopharyngeal (LP) sensory discrimination thresholds by delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve via a flexible endoscope. A prospective study was conducted of FEESST in 20 healthy control subjects, mean age of 34 +/- 11 years. LP sensory thresholds were defined as either normal (< 4.0 mmHg air pulse pressure [APP]), moderate deficit (4.0-6.0 mmHg APP), or severe deficits (> 6.0 mmHg APP). Subsequent to LP sensory testing, food of varying consistencies, mixed with green food coloring, was given and attention was paid to spillage, laryngeal penetration, pharyngeal residue, aspiration, and reflux. Therapeutic maneuvers such as postural changes and airway protection techniques were performed on each subject to determine if the assessed swallowing parameters were affected by maneuvers. All patients completed the study; all had normal LP sensory discrimination thresholds (2.9 +/- 0.7 mmHg APP). There were no instances of spillage, laryngeal penetration, or aspiration. Two of 20 subjects had pharyngeal residue and 2 of 20 had reflux. Institution of therapeutic maneuvers resulted in a predictable change in the endoscopic view of the laryngopharyngeal anatomy. FEESST provides comprehensive, objective sensory and motor information about deglutition in the bedside setting and might have implications for the bedside diagnosis and management of patients with dysphagia.

Laryngopharyngeal sensory testing with modified barium swallow as predictors of aspiration pneumonia after stroke.

Improved diagnostic tests that can accurately identify subjects at high risk for aspiration pneumonia (AP) are needed. One measure of this accuracy is the false-negative rate (FNR), which determines the failure of a test to identify a group at high risk. This study compares FNRs for AP among dysphagic stroke patients for two prognostic techniques: modified barium swallow (MBS) alone and MBS combined with laryngopharyngeal sensory discrimination testing (MBS + LPSDT). MBS and LPSDT were performed within 4 weeks of stroke in 20 subjects who were prospectively followed for at least 2 years to identify the frequency of AP. MBS identified 10 patients as not at risk based on the finding of no aspiration on initial MBS; four of these patients developed AP (FNR = 40%). MBS + LPSDT identified five patients as not at risk based on the findings of neither aspiration nor bilateral sensory deficits; none of these patients developed AP (FNR = 0%). The combination of MBS criterion (aspiration) with the LPSDT criterion (bilateral sensory deficits) improves prognostication of outcome in dysphagic stroke patients by identifying a subgroup at high risk for developing AP (nonaspirators with bilateral deficits).